THE JOURNAL OF INFECTIOUS DISEASES. VOL. 137. NO.3. MARCH 1978 © 1978 by The University of Chicago. 0022-1899178/3703-0006$00.75
Epidemiology of Hepatitis B Surface Antigen (HBsAg) and Antibody to HBsAg in Hospital Personnel From the Institute of Microbiology, Outpatient's Department for Medical Personnel, Institute of Biometrics and Medical Informatics, Medical School of Hannover, Hannover, West Germany
Jorg Janzen, Ioannis Tripatzis, Ursula Wagner, Marianne Schlieter, Ellen Muller-Dethard, and Enno Wolters
In 1948 hepatitis was acknowledged for the first time as an occupational disease of medical staff by the New York State Workmen's Compensation Board [1]. Viral hepatitis is now the most frequent occupational disease in this professional group, and its incidence has increased during recent years. Of 1,639 illnesses reported to the Professional Association for Sanitary Service and Welfare Work in the Federal Republic of Germany, 72% were cases of viral hepatitis. In 1969 an average of 35 of 10,000 hospital employees in the medical profession contracted hepatitis. Compared with the incidence of hepatitis in the general population, which is 3.5 cases among 10,000 persons per year, the risk of hepatitis is 10 times higher in hospital personnel. Similar frequencies have been reported from the United States [2], Sweden [3], and Austria [4]. In Sweden about 14% of all physicians who were interviewed
declared that they had had hepatitis [5, 6]. The problem of hepatitis among staff of dialysis units is shown by deaths reported from this professional group from 1965 to 1971 [7-1I]. To obtain a general view of the epidemiology of viral hepatitis type B in hospital personnel, we tried to answer the following questions in a study concerning the personnel of the Medical School of Hannover (Hannover, West Germany) from April 1974 to October 1975. (1) What is the state of dissemination of hepatitis B virus (HBV) among hospital personnel? (2) Which professions in the hospital are at a high risk for hepatitis? (3) Are there differences concerning this risk among the various professional departments? (4) Are there correlations between history of hepatitis, history of surgery, or the nursing of patients with hepatitis and the serologic detection of an infection with HBV?
Received for publication July 11, 1977, and in revised form October 18. 1977. This work was supported by the Deutsche Forschungsgemeinschaft. Please address requests for reprints to Dr. Joannis Tripatzis, Institut fur Mikrobiologie, Medizinische Hochschule Hannover, Karl-Wiechert-Allee 9, D-3000 Hannover 61, Went Germany.
Materials and Methods
Study population. In the course of routine medical examination of the personnel, the sera of all employees of the medical school were tested for hepatitis B surface antigen (HBsAg) and the corresponding antibody (anti-HBs). Thus
261
Downloaded from http://jid.oxfordjournals.org/ at University of Sussex on August 12, 2015
The epidemiology of hepatitis B in hospital personnel was studied by testing of sera from 3.770 employees of the Medical School of Hannover (Hannover, West Germany) for hepatitis B surface antigen (HBsAg) and its corresponding antibody (anti-HBs) by solid-phase radioimmunoassay. An average prevalence of 2.2% for HBsAg and 11.7% for anti-HBs was found. Physicians (18.2%). nurses (20.1%), and members of the cleaning service (26.3%) showed the highest frequencies of HBsAg or anti-HBs carriage. In a study of age- and sex-matched personnel, nurses showed a significantly (P < 0.01) higher rate of infection than a control group with less exposure to infectious mate~ials. The frequency of HBsAg or anti-HBs was highest in persons associated with dialysis (31.3%), anesthesiology (31.0%), ophthalmology (29.4%), neurosurgery (28.0%), and surgery (24.4%). The rate of infection was significantly higher in surgical departments (24.4%) than in nonsurgical ones (13.3%). Persons who had been nursing patients with hepatitis were significantly (P < 0.05) more frequently carriers of HBsAg or anti-HBs than a comparable control group.
Janzen et at,
262
employees from whom completed data were available. Men proved to be significantly (P < 0.05) more frequently HBsAg-positive (4.2% of 655) than women (2.1% of 1,170), whereas the prevalence of anti-HBs was equal in men (11.9%) and women (11.6%). The prevalence of both HBsAg and anti-HBs increased with age (table 2). This increase proved to be significant, in a trend test performed according to Maxwell [14], for all professions as well as for medical professions. The physicians (18.2%), nurses (20.5%), and members of the cleaning staff (26.3%) were most frequently infected (table 3). A significantly higher prevalence of HBsAg or anti-fIBs was found in members of the nursing staff (17.9%) than in an age- and sex-matched control group (7.5%) of members of the administration and technical service who had little exposure to blood or patients. The differences among physicians, medical technicians, and the age- and sex-matched control groups (table 4) were not statistically significant. The highest rates of carriage of HBsAg or anti-HBs were found in
Results
A total of 5,400 sera from 3,770 employees of the medical school were tested for HBsAg and anti-HBs. HBsAg was detected in the sera of 83 (2.2%) of the employees, and anti-HBs was detected in 442 (11.7%). In three cases we found both HBsAg and anti-HBs, and in three other cases a seroconversion from HBsAg to anti-HBs was observed. A total of 531 persons (14.1%) showed serologic signs of an infection with HBV. The following results were obtained from 1,825 Table 1. The distribution of average ages in various professional personnel studied for carriage of hepatitis B surface antigen and its corresponding antibody. Professional group
No. tested
Physicians Nurses Medical technicians Medical students Cleaning service Technical service Administration Other
203 469 324 139 38 282 123 53
Average age ±SD (years) 35.1 30.3 28.2 25.2 38.6 36.0 36.5 28.0
±6.9 ± 10.3 ±8.9 ± 2.7 ± 12.4 ± 11.1 ± 13.2 ±9.6
Table 2. Prevalence of hepatitis B surface antigen (HBsAg) and its corresponding antibody (anti-HBs) in hospital personnel of various ages. No. of persons (%) with Age (years), no. tested*
0;;;20 A,221 M,181 21-30 A, 879 M,723 31-40 A, 434 M,289 41-50 A, 188 M,93 ;;'51 A,86 M,31
HBsAg or anti-HBst
HBsAg
Anti-HBs
4 (1.8) 4 (2.2)
5 (2.3) 5 (2.8)
9 (4.1) 9 (5.0)
21 (2.4) 19 (2.6)
75 (8.5) 66 (9.1)
96 (10.9) 85 (11.8)
14 (3.2) 11 (3.8)
62 (14.3) 44 (15.2)
76(17.5) 55 (19.0)
10 (5.3) 6 (6.5)
43 (22.9) 26 (28.0)
53 (28.2) 32 (34.4)
4 (4.7) 0
28 (32.6) 12 (38.7)
32(37.2) 12 (38.7)
*A = all professions, and M = medical professions only (physicians, nurses, medical technicians, medical students, student nurses, and student technicians). tSignificant increase with age according to test of Maxwell [14]. For group A, x2 = 93.1, P
Epidemiology of Hepatitis B Surface Antigen (HBsAg) and Antibody to HBsAg in Hospital Personnel From the Institute of Microbiology, Outpatient's Department for Medical Personnel, Institute of Biometrics and Medical Informatics, Medical School of Hannover, Hannover, West Germany
Jorg Janzen, Ioannis Tripatzis, Ursula Wagner, Marianne Schlieter, Ellen Muller-Dethard, and Enno Wolters
In 1948 hepatitis was acknowledged for the first time as an occupational disease of medical staff by the New York State Workmen's Compensation Board [1]. Viral hepatitis is now the most frequent occupational disease in this professional group, and its incidence has increased during recent years. Of 1,639 illnesses reported to the Professional Association for Sanitary Service and Welfare Work in the Federal Republic of Germany, 72% were cases of viral hepatitis. In 1969 an average of 35 of 10,000 hospital employees in the medical profession contracted hepatitis. Compared with the incidence of hepatitis in the general population, which is 3.5 cases among 10,000 persons per year, the risk of hepatitis is 10 times higher in hospital personnel. Similar frequencies have been reported from the United States [2], Sweden [3], and Austria [4]. In Sweden about 14% of all physicians who were interviewed
declared that they had had hepatitis [5, 6]. The problem of hepatitis among staff of dialysis units is shown by deaths reported from this professional group from 1965 to 1971 [7-1I]. To obtain a general view of the epidemiology of viral hepatitis type B in hospital personnel, we tried to answer the following questions in a study concerning the personnel of the Medical School of Hannover (Hannover, West Germany) from April 1974 to October 1975. (1) What is the state of dissemination of hepatitis B virus (HBV) among hospital personnel? (2) Which professions in the hospital are at a high risk for hepatitis? (3) Are there differences concerning this risk among the various professional departments? (4) Are there correlations between history of hepatitis, history of surgery, or the nursing of patients with hepatitis and the serologic detection of an infection with HBV?
Received for publication July 11, 1977, and in revised form October 18. 1977. This work was supported by the Deutsche Forschungsgemeinschaft. Please address requests for reprints to Dr. Joannis Tripatzis, Institut fur Mikrobiologie, Medizinische Hochschule Hannover, Karl-Wiechert-Allee 9, D-3000 Hannover 61, Went Germany.
Materials and Methods
Study population. In the course of routine medical examination of the personnel, the sera of all employees of the medical school were tested for hepatitis B surface antigen (HBsAg) and the corresponding antibody (anti-HBs). Thus
261
Downloaded from http://jid.oxfordjournals.org/ at University of Sussex on August 12, 2015
The epidemiology of hepatitis B in hospital personnel was studied by testing of sera from 3.770 employees of the Medical School of Hannover (Hannover, West Germany) for hepatitis B surface antigen (HBsAg) and its corresponding antibody (anti-HBs) by solid-phase radioimmunoassay. An average prevalence of 2.2% for HBsAg and 11.7% for anti-HBs was found. Physicians (18.2%). nurses (20.1%), and members of the cleaning service (26.3%) showed the highest frequencies of HBsAg or anti-HBs carriage. In a study of age- and sex-matched personnel, nurses showed a significantly (P < 0.01) higher rate of infection than a control group with less exposure to infectious mate~ials. The frequency of HBsAg or anti-HBs was highest in persons associated with dialysis (31.3%), anesthesiology (31.0%), ophthalmology (29.4%), neurosurgery (28.0%), and surgery (24.4%). The rate of infection was significantly higher in surgical departments (24.4%) than in nonsurgical ones (13.3%). Persons who had been nursing patients with hepatitis were significantly (P < 0.05) more frequently carriers of HBsAg or anti-HBs than a comparable control group.
Janzen et at,
262
employees from whom completed data were available. Men proved to be significantly (P < 0.05) more frequently HBsAg-positive (4.2% of 655) than women (2.1% of 1,170), whereas the prevalence of anti-HBs was equal in men (11.9%) and women (11.6%). The prevalence of both HBsAg and anti-HBs increased with age (table 2). This increase proved to be significant, in a trend test performed according to Maxwell [14], for all professions as well as for medical professions. The physicians (18.2%), nurses (20.5%), and members of the cleaning staff (26.3%) were most frequently infected (table 3). A significantly higher prevalence of HBsAg or anti-fIBs was found in members of the nursing staff (17.9%) than in an age- and sex-matched control group (7.5%) of members of the administration and technical service who had little exposure to blood or patients. The differences among physicians, medical technicians, and the age- and sex-matched control groups (table 4) were not statistically significant. The highest rates of carriage of HBsAg or anti-HBs were found in
Results
A total of 5,400 sera from 3,770 employees of the medical school were tested for HBsAg and anti-HBs. HBsAg was detected in the sera of 83 (2.2%) of the employees, and anti-HBs was detected in 442 (11.7%). In three cases we found both HBsAg and anti-HBs, and in three other cases a seroconversion from HBsAg to anti-HBs was observed. A total of 531 persons (14.1%) showed serologic signs of an infection with HBV. The following results were obtained from 1,825 Table 1. The distribution of average ages in various professional personnel studied for carriage of hepatitis B surface antigen and its corresponding antibody. Professional group
No. tested
Physicians Nurses Medical technicians Medical students Cleaning service Technical service Administration Other
203 469 324 139 38 282 123 53
Average age ±SD (years) 35.1 30.3 28.2 25.2 38.6 36.0 36.5 28.0
±6.9 ± 10.3 ±8.9 ± 2.7 ± 12.4 ± 11.1 ± 13.2 ±9.6
Table 2. Prevalence of hepatitis B surface antigen (HBsAg) and its corresponding antibody (anti-HBs) in hospital personnel of various ages. No. of persons (%) with Age (years), no. tested*
0;;;20 A,221 M,181 21-30 A, 879 M,723 31-40 A, 434 M,289 41-50 A, 188 M,93 ;;'51 A,86 M,31
HBsAg or anti-HBst
HBsAg
Anti-HBs
4 (1.8) 4 (2.2)
5 (2.3) 5 (2.8)
9 (4.1) 9 (5.0)
21 (2.4) 19 (2.6)
75 (8.5) 66 (9.1)
96 (10.9) 85 (11.8)
14 (3.2) 11 (3.8)
62 (14.3) 44 (15.2)
76(17.5) 55 (19.0)
10 (5.3) 6 (6.5)
43 (22.9) 26 (28.0)
53 (28.2) 32 (34.4)
4 (4.7) 0
28 (32.6) 12 (38.7)
32(37.2) 12 (38.7)
*A = all professions, and M = medical professions only (physicians, nurses, medical technicians, medical students, student nurses, and student technicians). tSignificant increase with age according to test of Maxwell [14]. For group A, x2 = 93.1, P
